Summary Paragraph
Despite effective countermeasures, SARS-CoV-2 persists worldwide due to its ability to diversify and evade human immunity1. This evasion stems from amino-acid substitutions, particularly in the receptor-binding domain of the spike, that confer resistance to vaccines and antibodies 2–16. To constrain viral escape through resistance mutations, we combined antibody variable regions that recognize different receptor binding domain (RBD) sites17,18 into multispecific antibodies. Here, we describe multispecific antibodies, including a trispecific that prevented virus escape >3000-fold more potently than the most effective clinical antibody or mixtures of the parental antibodies. Despite being generated before the evolution of Omicron, this trispecific antibody potently neutralized all previous variants of concern and major Omicron variants, including the most recent BA.4/BA.5 strains at nanomolar concentrations. Negative stain electron microscopy revealed that synergistic neutralization was achieved by engaging different epitopes in specific orientations that facilitated inter-spike binding. An optimized trispecific antibody also protected Syrian hamsters against Omicron variants BA.1, BA.2 and BA.5, each of which uses different amino acid substitutions to mediate escape from therapeutic antibodies. Such multispecific antibodies decrease the likelihood of SARS-CoV-2 escape, simplify treatment, and maximize coverage, providing a strategy for universal antibody therapies that could help eliminate pandemic spread for this and other pathogens.
Competing Interest Statement
T.Z., L.W., J.M., A.P., Y.Z., E.S.Y., W.S., J.R.M, N.J.S., and P.D.K. are inventors on US patent application No. 63/147,419. R.R.W., Z-y.Y. and G.J.N are inventors on patent WO2017180913A. J.L., G.J.N., C-J.W., R.R.W., Z-y. Y. are employees of ModeX Therapeutics Inc., an OPKO Health Company. G.J.N., C-J.W, R.R.W. and Z-Y. Y. are inventors on US patent application Nos. 63/357,336 and 63/357,873. J.M., A.P., L.W., T.Z., M.C., O.K.O., B.Z., Y.Z., E.S.Y., M.C, K.L., W.S., N.J.S., J.R.M., P.D.K. and R.A.K. are inventors on the same application.
Footnotes
revision of text, figures and addition of new data
